Speech-Language Evaluations and Augmentative Communication. Julie Demes, MS, CCC-SLP

Transcription

1 Speech-Language Evaluations and Augmentative Communication Julie Demes, MS, CCC-SLP 1

2 Overview What is a comprehensive speechlanguage evaluation? Speech-language service delivery and goals What is augmentative and alternative communication (AAC)? 2

3 Speech or Language Impairment a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child s educational performance. (ISBE, 2009) 3

4 Qualified Evaluators Speech-Language Pathologists ASHA Certificate of Clinical Competence Master s or Doctoral degree Complete supervised postgraduate experience (9-12mos Clinical Fellowship) Pass national examination Professional development (30 hrs/3 yrs) State licensure (required in IL) Supervised CFY-SLPs and SLPAs 4

5 Comprehensive Speech- Language Evaluation ASHA and WHO dictate standards Eval must include: Case history Student/family interview Record review Assessment of specific aspects of S-L Recommendations 5

6 Specific Areas Assessed Oral Mechanism: structure, function Speech: sound production, intelligibility Language: receptive, expressive, pragmatic Voice: quality, pitch, loudness Fluency: stuttering, cluttering Cognition: typically assessed by teacher and/or school psychologist 6

7 Speech-Language Assessments Oral-Speech Motor Oral Speech Mechanism Screening Examination pass/fail screener 5-78yrs complete additional speech and/or feeding evaluations refer to neurologist or other professional Kaufman Speech Praxis Test for Children Norm-referenced 2-5:11yrs Diagnose Developmental Apraxia of Speech 7

8 Speech-Language Assessments Articulation/Phonology Goldman-Fristoe Test of Articulation Norm-referenced 2-21:11yrs Diagnose Speech Sound/Articulation Disorder Khan-Lewis Phonological Analysis Norm-referenced 2-21:11yrs Diagnose Speech Sound/Phonological Disorder 8

9 Language Speech-Language Assessments Preschool Language Scale Norm-referenced Birth-7;11yrs Diagnose Language Impairments/Disorders Clinical Evaluation of Language Fundamentals Norm-referenced 5-21yrs Diagnose Language Impairments/Disorders 9

10 Voice Speech-Language Assessments Voice quality, nasality, pitch and loudness are subjectively judged by SLP Refer to pediatrician or otolaryngologist Diagnosis of laryngeal pathology requires videostroboscopy Fluency Stuttering Severity Instrument Norm-referenced 2-10yrs and up Diagnose Stuttering and Determine Severity 10

11 Determining Severity Standard Score of 100 = average Standard Score of = no services Standard Deviations (SD) below mean = Mild Impairment SDs below mean = Moderate Impairment >2.5 SDs below mean = Severe-Profound Impairment 11

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13 Severity and Eligibility ISBE Speech/Language Eligibility Criteria Matrix, (2009) Severity based on level of impact impairment has on individual s ability to communicate or respond in school Mild Impairment = minimally affects Moderate Impairment = interferes with Severe Impairment = limits Profound = prevents 13

14 Service Delivery Mild = mins per week Moderate = mins per week Severe = mins per week Profound = 91+ mins per week 14

15 Developing Goals Identify desired skill/behavior Level of support; quality Measurable; specify criteria Condition; Location Should be attainable within IEP year IEP goals must be linked to Common Core State Standards/New Illinois Learning Standards 15

16 Case Studies Assessment Impairment Type Severity Service Eligibility / Frequency Goals 16

17 What is AAC? AAC= Augmentative and Alternative Communication Any item that supplements or substitutes for verbal speech is considered AAC Variety of options: vocalizations, gestures, signs, communication boards, high tech speech generating devices 17

18 What is AAC? Supplements Speech: For those who are struggling to develop speech sounds or words; provides auditory feedback and speech model Replaces Speech: For those who can t speak at all it can act as their Voice (very rare- seen more in adults than kids) Aids Understanding: For those who are learning language, pictures on the device may help them understand. Children are visual learners. 18

19 Communication Devices that Span All Users & Abilities Nova Chat-7 DynaVox T10 with Compass software Vmax+ with EyeMax Accent 1000 Accessibility Options Low Physical & Motor Challenges Full Portfolio of Solutions to Meet Student s Needs High

20 Who Can Use AAC? Anyone who struggles with language and speech is a candidate to try AAC THERE ARE NO PREREQUISITES FOR AAC Can teach communication before means-end behavior established (Reichle & Yoder, 1985) AAC systems may be warranted for individuals with severe-profound speech sound and/or language impairments. (ISBE, 2009) 20

21 Research in AAC Research reveals that implementing AAC positively impacts Language Cognition Literacy skills Participation in social, educational and play environments All of these are important developmentally to young children (Beukelman & Mirenda, 2005; Branson & Demchak, 2009; Drager et. al., 2003; Romski & Sevcik, 2005). 21

22 Why is AAC developmentally appropriate? Children learn language through experiencing it Typically developing children babble and play with sounds before speaking their first words They talk and experiment with language; they are able to imitate to practice and learn Children who cannot speak effectively are essentially unable to verbally play They are unable to get the verbal practice they need to develop effective receptive and expressive language like their peers 22

23 Why is AAC developmentally appropriate? AAC provides children the ability to: Ask for favorite toys, books like other peers Play developmentally appropriate games (e.g., tickling, peek a boo), sing songs, etc., to develop social relationships Engage in pretend play with peers or adults Ask questions, share feelings and thoughts Learn preschool concepts such as color, shape, numbers, letter sounds, etc. Express needs/wants (developmentally appropriate) 23

24 Why is AAC developmentally AAC Enhances appropriate? All learning (as all learning has a language component); it can be used to introduce concepts Language development (broad vocabulary, increasing to combining vocabulary to create complex messages) Concept development Functional Communication Social Interaction (turn taking, engagement) Foundations for literacy development (left to right, letter concepts) Categorization Sequencing 24

25 What types of AAC are Low Tech available? Communication Books, Boards PECS Visual Schedules These are all valid uses of symbols, but are limited in that they do not have auditory feedback 25

26 What types of AAC are available? Light Tech speech generating devices Digitized (recorded) speech Limited number of options available on each level ; need to create paper overlays Minimal options for experimentation with language, not a consistent model NOT a prerequisite for high tech AAC devices 26

27 What types of AAC are available? High Tech AAC Devices Have specific, developmentally appropriate language organization Contains concepts at a variety of language levels Highly customizable Synthesized speech; consistent voice, therefore consistent model 27

28 What types of AAC are High Tech Devices available? Generally Dynamic Display (changes when something is pressed ) Variety of sizes, getting smaller and smaller! Language systems that are evidence based and support language and literacy development Durable Medical Equipment - can be repaired for 5+ years, local support, tech support Often, a variety of languages available *** Typically covered by Insurance 28

29 What types of AAC are available? Access Methods Simple Touch (most common) Touch Enter/Exit Keyguards Scanning Alternative Mouse/Head mouse Eye Gaze 29

30 What does a language Core Vocabulary system look like? Most common 100 words in English Sentence Builders - generating and combining single words Contextual Social Vocabulary Topic Based Messages /phrase based Quick access to control social situations Visual supports Schedules, timers, social stories 30

31 AAC Evaluations Comprehensive S-L Evaluation Team Collaboration Mobility and Motor Access Method Device Trials Low-High Tech Screen size and access Language systems 4-6 week extended trial Vary based on funding source 31

32 Available Resources Illinois Assistive Technology Project Offers short term loan devices (At times 10+ week waiting list for newer devices) 32

33 References Beukelman & Mirenda, 2005 Branson & Demchak, 2009 DeThorne, 2009 Drager et. al., 2003 Drager et. al. (2004) Light, 1989 Light and Drager, 2007 Romski & Sevcik, 2005 Schepis,

34 References American Speech-Language Hearing Association, (2007). Scope of practice in speech-language pathology [Scope of Practice]. Available from American Speech-Language Hearing Association. (2004). Preferred practice patterns for the profession of speech-language pathology [Preferred Practice Patterns]. Available from American Speech-Language Hearing Association. Directory of Speech-Language Pathology Assessment Instruments. Available from Simple Graphic Bell Curve Chart 34

35 Illinois State Board of Education, (2009). Education rights and responsibilities: understanding special education in Illinois. Kangas, K.A. and Lloyd, L. (1988). Early cognitive skills as prerequisites to augmentative and alternative communication use: What are we waiting for? Augmentative and Alternative Communication, 4 (4), Reichle, J., & Yoder, D. (1985). Communication board use in severely handicapped learners. Language, Speech, Hearing Services in Schools, 16, Romski, M. A., Sevcik, R. A., & Pate, J. L. (1988). The establishment of symbolic communication in persons with mental retardation. Journal of Speech and Hearing Disorders, 53,

36 References Shane, H. & Bashir, A. (1980). Election criteria for the adoption of an augmentative communication system: Preliminary considerations. Journal of Speech and Hearing Disorders, 45,